Los suplementos dietéticos pueden suponer graves riesgos para el hígado
Muchos adultos toman suplementos dietéticos asumiendo que son beneficiosos para su salud. Sin embargo, un estudio de EE. UU. indica ahora que los suplementos dietéticos y a base de hierbas también conllevan un riesgo potencial para el hígado. Según los datos publicados en "Hepatology", estos suplementos conducen con más frecuencia a trasplantes de hígado y lesiones graves causantes de muerte en comparación con los medicamentos y los suplementos para culturismo.
En su estudio, los investigadores del Centro Médico Einstein de Filadelfia (Pensilvania) incluyeron a 839 pacientes con lesiones hepáticas que estaban siendo tratados en ocho centros de referencia de la Red de lesiones hepáticas inducidas por fármacos entre 2004 y 2013. Se produjeron 45 casos por suplementos para culturismo, 85 por otros suplementos y 709 por medicamentos. Durante el periodo del estudio, la proporción de lesiones hepáticas debidas a suplementos dietéticos o a base de hierbas entre los participantes aumentó del siete al veinte por ciento.
Los suplementos para culturismo normalmente causaron ictericia prolongada (91 días) en hombres jóvenes, pero no condujeron a daños hepáticos graves o muertes. Los suplementos a base de hierbas fueron responsables del 13 por ciento de trasplantes de hígado o incluso de muertes, mientras que este solo fue el caso en el tres por ciento de los que tomaban medicamentos convencionales. El daño hepático a partir de los suplementos dietéticos fue más común en mujeres de mediana edad.
"Mientras que muchos estadounidenses creen que los suplementos son seguros, los reglamentos gubernamentales exigen menos pruebas de seguridad para comercializar los productos de las que se requieren para los productos farmacéuticos convencionales", explicó el autor del estudio, Víctor Navarro. Por tanto, el riesgo de efectos secundarios perjudiciales es mayor.
Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network
Article first published online: 25 AUG 2014
DOI: 10.1002/hep.27317
© 2014 by the American Association for the Study of Liver Diseases
Additional Information(Show All)
- Potential conflict of interest: Dr. Bonkovsky consults, advises, and received grants from Clinuvel. He consults and advises Alnylam and Recordati. He received grants from Vertex. Dr. Fontana consults for GlaxoSmithKline and received grants from Bristol-Myers Squibb, Gilead, Janssen, and Vertex. Dr. Reddy advises and received grants from Merck, Gilead, AbbVie, Bristol-Myers Squibb, Vertex, and Janssen. He advises Genentech-Roche and received grants from Genfit.
- The Drug Induced Liver Injury Network (DILIN) is a cooperative network funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). See the DILIN website (https://dilin.dcri.duke.edu/publications-1) for a complete listing of funding sources, sites, investigators, coinvestigators, coordinators, and staff.
- Trial Registration: The Drug-Induced Liver Injury Network (DILIN), ClinicalTrials.gov Identifier: NCT00345930 (https://dilin.dcri.duke.edu/).
The Drug-Induced Liver Injury Network (DILIN) studies hepatotoxicity caused by conventional medications as well as herbals and dietary supplements (HDS). To characterize hepatotoxicity and its outcomes from HDS versus medications, patients with hepatotoxicity attributed to medications or HDS were enrolled prospectively between 2004 and 2013. The study took place among eight U.S. referral centers that are part of the DILIN. Consecutive patients with liver injury referred to a DILIN center were eligible. The final sample comprised 130 (15.5%) of all subjects enrolled (839) who were judged to have experienced liver injury caused by HDS. Hepatotoxicity caused by HDS was evaluated by expert opinion. Demographic and clinical characteristics and outcome assessments, including death and liver transplantation (LT), were ascertained. Cases were stratified and compared according to the type of agent implicated in liver injury; 45 had injury caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Liver injury caused by HDS increased from 7% to 20% (P < 0.001) during the study period. Bodybuilding HDS caused prolonged jaundice (median, 91 days) in young men, but did not result in any fatalities or LT. The remaining HDS cases presented as hepatocellular injury, predominantly in middle-aged women, and, more frequently, led to death or transplantation, compared to injury from medications (13% vs. 3%; P < 0.05). Conclusions: The proportion of liver injury cases attributed to HDS in DILIN has increased significantly. Liver injury from nonbodybuilding HDS is more severe than from bodybuilding HDS or medications, as evidenced by differences in unfavorable outcomes (death and transplantation). (Hepatology 2014)
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